Popliteal Research Articles

Unusual Presentation of Brucellosis in Baker's Cyst

A 55-year-old diabetic male came with history of left knee pain and swelling for 7 days, fever for 3 days, and no history of trauma. He was complaining of tenderness on the left popliteal fossa, and the surrounding area was red and soft to firm swelling; he was limping, and could not bear weight on the left leg. The ultrasound showed that there was a well-defined heterogeneous hypoechoic cystic lesion. Under aseptic technique, continuous US guidance and local anesthesia, we aspirated almost all the fluid of the left calf collection, which was reported as complicated baker cyst. The patient was put on ciprofloxacin, gentamycin, and doxycycline. The patient was cleared from infectious diseases’ team and discharged after 7 days. J Med Cases. 2015;6(10):450-452 doi: http://dx.doi.org/10.14740/jmc2252w

The diagnostic value of thromboelastography and D-dimer on anticoagulation therapy concurrenting DVT in the perioperative period of arthroplasty replacement

Objective To investigate the predictive value and clinical significance of dynamic monitoring of thromboelastography (TEG) and D-dimer on anticoagulation therapy concurrenting DVT in the perioperative period of arthroplasty replacement. Methods All of 60 patients of total knee arthroplasty (TKA) were selected as patient group from 2011 to 2013. They were divided into low molecular weight heparin (LMWH) group and rivaroxaban group according to random number table. LMWH group was given LMWH (xi fu quan) 4250 IUAXa 12 h after knee replacement, im, qd for 7 days, then rivaroxaban 10 mg, qd for 7 days. Rivaroxaban group was given rivaroxaban 10 mg 6 h after knee replacement, qd for 14 days. Meanwhile, 42 health examination participants were selected as control group. The parameters of TEG were detected by TEG 5000 thromboelastograph hemostasis system (American Haemoscope Corporation). Results D-dimer levels of postoperative before anticoagulation therapy were highest and there was statistical difference, while other parameters had no statistical difference. Intra-group comparison: the levels of R, K, Alpha, CI of TEG and D-D in LMWH group and the levels of Alpha, MA, CI of TEG and D-D in rivaroxaban group had statistical difference, while other parameters' levels showed no statistical difference. At anticoagulation treatment endpoint, DVT occurred in 8 cases with an incidence of 13.3% (8/60). 7 cases were intramuscular vein thrombosis, and 1 case was popliteal vein thrombosis. The levels of Alpha, MA, CI of TEG and D-D in DVT group were higher than no DVT group, and there was statistical difference. TEG's CI, MA, Alpha and D-dimer had better clinical diagnostic value on DVT, whose area under receiver operating characteristic cure (ROC) respectively was 0.746, 0.733, 0.707 and 0.644, with sensitivity of 75%, 75%, 62.5% and 62.5%, specificity of 80.8%, 76.9%, 78.8% and 71.1%, positive predictive value of 37.5%, 33.3%, 31.3% and 25.0%, and negative predictive value of 95.4%, 95.2%, 93.2% and 93.1%. MA=68.35 mm was the best clinical diagnosis of critical point on DVT at anticoagulation treatment endpoint. Conclusion CI, MA, Alpha of TEG are better than D-dimer in predicting the incidence of DVT in the perioperative period of orthopaedics major operation. If these indexes are detected, the diagnosis value's accuracy of DVT will be improved. Key words: Arthroplasty, replacement, knee; Venous thrombosis; Thrombelastography; ROC curve

Stationary cycle training for improving lower limb muscle tension and motor function in children with spastic cerebral palsy

Objective To observe the effects of stationary cycle training on lower limb muscle tension and motor function in children with spastic cerebral palsy. Methods Sixty-seven children with spastic cerebral palsy were divided into a treatment group (n=34) and a control group (n=33). Both were treated with routine rehabilitation therapy, including neurodevelopment treatment, massage and physical agent therapy. The treatment group additionally cycled on a stationary bicycle for 20 min a day, five days a week for 3 months. Muscle tension in the children's adductor, hamstring and gastrocnemius muscles was evaluated using the modified Ashworth scale (MAS), while the adductor angle, popliteal fossa angle and foot dorsiflexion angle were measured using a joint protractor. Moreover, the 88-item version of the Gross Motor Function Measure (GMFM-88) was used to evaluate gross motor function. Results After treatment the average muscle tension of both groups was significantly lower than before treatment. The average muscle tension scores of the adductors, hamstrings and calf muscles of the treatment group [(1.79±0.54), (1.00±0.60), (2.29±1.77)] were significantly lower than those of the controls [(1.82±0.53), (1.15±0.44), (2.52±1.89)]. The adductor angles, popliteal fossa angles and foot dorsiflexion angles of both groups were significantly larger than before treatment, and the angles in the treatment group [(97.06±19.03)°, (53.38±12.54)° and (8.38±9.11 )° respectively] were significantly larger on average than those in the control [(98.94±21.42)°, (56.52±12.90 )° and ( 5.30±14.30)° respectively]. After treatment the total GMFM scores of both groups were better than before treatment, but the treatment group's average score(138.18±54.86) was significantly better than that of the control group(112.21±62.44). Conclusion Three months of stationary cycle training can effectively reduce the muscle tension of children with spastic cerebral palsy and improve their motor function. Key words: Cerebral palsy, spastic; Muscle tension; Joint motion range; Exercise therapy; Motor function; Stationary cycle training

Research of correlative factors between the ultrasonography of trauma-caused deep venous free-floating thrombus of lower limbs and the prognosis

Objective To analyze the color Doppler ultrasonography of trauma-caused deep venous free-floating thrombus(FFT) of lower limbs, discuss the relations between sonography and the prognosis. Methods Clinical data and color Doppler ultrasound examination results of 130 cases with trauma-caused deep venous FFT of lower limbs were retrospectively analysed. Univariate analysis was conducted to identify the statistically significant factors of patients′ prognosis, non-conditional logistic regression analysis was performed to analyse the independent prognostic factors of FFT. Results The non-conditional logistic regression analysis showed that the position of FFT, thrombosis edge definition, floating degree and the volume of detouring blood around the thrombus were independent factors of patients′ prognosis(P<0.05). The FFT prognosis of iliofemoral vein was more likely to be fixed than the FFT prognosis of popliteal vein. The FFT prognosis with blurring edges was more likely to be fixed. The more obvious the floating degree of FFT, the higher chance that the FFT prognosis is recanalized. More detouring blood flow around FFT indicated more possibilities that the prognosis could be recanalized. Conclusions The color Doppler ultrasound is able to evaluate the relations between the deep venous free-floating thrombus of lower limbs and prognosis of the patients, which is beneficial for early detection and early treatment, as well as reducing mortality and disability resulted from deep venous thrombus during the orthopaedic perioperative period. Key words: Ultrasonography, Doppler, color; Deep venous thrombosis; Free-floating thrombus; Prognosis

Hyalinizing Spindle Cell Tumour with Giant Rosettes (HSCTGR) - A sequelae neurofibromatosis

Generalised neurofibromatosis (von Recklinghausens disease) 1:4000 birth is an inherited autosomal dominant disease wherein there will be multiple neuro fibromas in the body- Chromosome 17. Usual indication for excision is symptomatic neurofibroma-pain and pressure symptoms, cosmetically problematic lesion, recent increase in size, malignant transformation seen in 5 % cases. We present a very rare case- 66 year old male who underwent excision of a symptomatic neurofibroma over left popliteal joint. Three months post-operatively patient developed a fast growing tumour measuring 10 X 6 cm at the operated site. FNAC report revealed hyalinizing spindle cell tumour with giant rosettes (HSCTGR). The rarity of this tumor is demonstrated by the small number of cases available; to date, only 38 cases have been reported in the world literature.

The evaluation of popliteal fossa fixed method to reduce setup errors for postoperative cervical cancer via CBCT

Objective To evaluate the effect of popliteal fossa fixed method to reduce the setup errors in patients with postoperative cervical carcinoma by CBCT of TrueBeam Linear accelerator. Methods 30 cases of postoperative cervical cancer patients were randomly divided into two groups, group A with popliteal fossa fixed method by trapezoidal fixation, group B with traditional vacuum pad fixation. CBCT was used to record both setup errors and rotational errors, Stroom extension formula was used to calculate the PTV expansion value coming from the two different fixation methods. Results There was significant difference in setup errors between group A and group B. The setup errors in the left-right direction (X), cranial-caudal direction (Y) and anterior-posterior direction (Z) were (0.19±0.14) cm, (0.17±0.12) cm and (0.13±0.11) cm in group A, respectively. On the contrary, the setup errors in X, Y and Z were (0.24±0.19) cm, (0.25±0.21) cm and (0.22±0.18) cm in group B, respectively. The rotational errors were 0.05°±0.02° in group A, comparing with 0.5°±0.21° in group B (P=0.00). The PTV expanded margin in group A was 0.56 cm in X direction, 0.51 cm in Y direction, 0.40 cm in Z direction, in comparing with 0.73 cm, 0.78 cm and 0.67 cm in group B, respectively. Group A remarkably reduced the PTV, pelvis, small intestine, bladder and rectum irradiated volumes [(1 167±271) mm3 vs (1 379±297) mm3, (84±12) mm3 vs (130±17) mm3, (81±51) mm3 vs (117±64) mm3, (62±40) mm3 vs (75±47) mm3, (21±16) mm3 vs (31±21) mm3]. Conclusion Popliteal fossa fixed method can reduce setup errors and improve the stability of positioning, more suitable in precise radiotherapy for postoperative cervical cancer patients, which has the value of further validation. Key words: Image-guided radiotherapy; Cervical cancer; Fixed position; Setup errors

Value of ultrasonography in the persistent sciatic artery

Objective To study the clinical value of color Doppler ultrasonography in the persistent sciatic artery. Methods The ultrasonographic images of eleven patients with persistent sciatic artery diagnosed by CT angiography or digital subtraction angiography were retrospective analyzed, the ultrasonographic features were summarized. Results The sciatic artery showed the enlarged internal iliac artery, which continued into the thigh in a posterior location, the sciatic artery described a tortuous course toward the knee, slowly filling normal-appearing popliteal artery in 8 cases, there were no connection with popliteal artery in 1 cases. The common femoral artery and superficial femoral artery was dysplasia in 7 patients, which was thinner than the popliteal artery. Conclusions The ultrasonography is the effective imaging method for diagnosis of the persistent sciatic artery. Key words: Ultrasonography; Sciatic artery

Analysis on optimal protocol of lower extremity MR angiography in patients with diabetic foot

Objective To explore the optimal protocol of lower-extremity contrast-enhanced MRA(CE-MRA) in the evaluation of diabetic foot. Methods Twenty eight healthy volunteers were scanned by CE-MRA in crus twice with parellel imaging factor (PIF) of 3 or 4. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and image quality of popliteal artery, posterior tibial artery, anterior tibial artery and peroneal artery were compared. Twenty patients with diabetic foot underwent CE-MRA by both of protocol 1 and 2 in leg, crus and foot. Protocol 1 was the traditional Care-bolus protocol and protocol 2 was the optimized K-space center filling delay-time protocol. The difference of two protocols in venous aliasing and in display of femoral artery, popliteal artery, posterior tibial artery, anterior tibial artery, peroneal artery, dorsalis pedis artery, medial plantar artery and lateral plantar artery were compared. The SNR, CNR of two different PIF sequences were compared by paired t test, and the display of artery of crus was compared by Wilcoxon. The display of vessels and venous aliasing of 2 protocols of diabetic foot patients were compared by Wilcoxon. Results In the images of healthy volunteers with PIF of 3, the SNR were 267±84,174±51, 147±42;and the CNR were 232±83,139±51,108±39 at popliteal artery, posterior tibial artery and peroneal artery. However, in the images with PIF of 4, the SNR were 239±73,157±53,132±35; and CNR were 206±71, 124±50,103±33, respectively. Both the SNR and CNR were higher in the former than in the latter(t values were 2.31 to 4.11, P 0.05).In the protocol 1 of patients with diabetic foot,the display of popliteal artery, posterior tibial artery, anterior tibial artery, peroneal artery, dorsalis pedis artery, medial plantar artery and lateral plantar artery, the venous aliasing in crus and foot were 3.40±0.82, 2.70±0.80, 2.50±1.00, 2.20±0.77, 2.30±0.92, 2.15±1.04, 1.45±0.60, 2.20±1.01, 2.20±1.06. And in the protocol 2, they were 3.85±0.37, 3.55± 0.69, 3.30±0.92, 2.90±0.79, 3.30±0.92, 3.25±0.79, 1.95±1.10, 3.70±0.47, 3.65±0.49, respectively(P<0.05). All of these parameters of protocol 2 were superior to protocol 1. Conclusion Using a higher PIF properly, setting the personalized K-space center filling delay-time can contribute to improving the image quality of whole lower-extremity MRA in patients with diabetic foot. Key words: Diabetic foot; Magnetic resonance angiography; Lower extremity

Stretching optimization for lower limb posterior chain: comparison between two different executions of the same exercise

Stretching of the posterior kinetic chain muscles, especially the hamstrings, is one of the most practiced exercises in all types of physical activity and postural rehabilitation protocols (1). Objective of our experimental trial was to compare the performance of two different variants of muscle stretching (A and B), highlighting for each one the regions of the posterior kinetic chain (lumbar region, gluteus muscles, hamstrings) most affected by the exercise. 161 selected subjects reported on a specific Body Chart the localization of the stretching sensation; the software Pain-drawing (2) was employed for the analysis of the stretching sensation felt by each subject (75 men and 86 women) aged between 20 and 80 years old, with different lifestyles but subjected to defined exclusion criteria (prosthesis, artificial implants, crippling arthritis, flare–up pain, recent surgical procedures). Stretching A is the generally accepted practice available in the literature. The proposed variant (Stretching B) is the experimental suggested procedure which adapts the execution of the exercise on biomechanical reasoning, in order to focus the stretching sensation on the hamstrings muscles and, at the same time, decreasing the stress in the lumbar region. In stretching B, subjects were positioned with lower limb in neutral position, knee with approximately 18° of feeble bending (variable depth, compact rolls in various size, behind popliteal fossa. Notably, results show that the same area has not been affected; when subjects performed Stretching B exercise avoids both the pre-tension of the hamstrings and the lever created by the arms stretched forward, focusing the stretching sensation on the hamstrings muscles and gastrocnemius and affecting only marginally the lumbar region and never the back region. This appears particularly relevant for the prevention of lower back pain and for situation when the stretching of the posterior kinetic chain is performed as a cool-down following physical activity or for rehabilitation purposes.

Comment to: Postoperative varicose recurrence at the junctions. A multicentric study of 1056 patients by the Italian Society of Phlebolymphology. Preliminary conclusions by Corcos L, Aloi T, Alonzo U, et al. Acta Phlebol 2014;15:69-78

In spite of a history and evidence of efficacy, numerous attempts have been made to replace traditional surgery with new techniques in the hypothesis that the surgical trauma and high pressure on the venous wall are responsible for the development of neovascularisation by neoangiogenesis (NN) and, consequently, high postoperative recurrent rates. To verify the anatomical causes of postoperative varices recurrence (VR) at the SFJ and SPJ fourteen centres belonging to the Italian Society of Phlebolymphology collected the requested data from 1056 patients (1081 limbs, 25 bilateral) who were either previously subjected to ligation-interruption of SFJ and/or SPJ (927 between 2001-2010) or treated in the last two years (154 between 2011-2012); 611 limbs (56.5%) were examined by DUS only, 470 limbs (43.4%) were subjected to DUS examination and surgical revision (270 with Li technique). The residual saphenous stump (SS), all residual tributaries with their outflows into the stump or directly into the common femoral or popliteal veins and their anatomical variants were investigated; neovascularisation by neoangiogenesis was investigated, searching for thin and tortuous veins measuring <2 mm in diameter and connected with an SS, with the common femoral vein or with thinner subcutaneous veins. The majority of the SS were found to be combined with residual identified or unidentified tributaries. In many cases, the VR consisted of a complex varicose collateral circulation (CVC). The residual SS (n=711, 65.7%) was the most common finding, followed (by decreased frequency) by the anterior accessory of the GSV (n=298, 27.5%), UT at the SFJ (n=290, 26.8%), superficial iliac circumflex vein (n=127, 11.7%), residual GSV (most likely from a previous duplicity), (n=95, 8.7%), superficial epigastric (n=60, 8.8%) A large number of cases with development of a CVC (n=386, 35.7%) were found in the supra-fascial subcutaneous. The anatomical residuals, which were single or multiple and variously combined, were found in a total of 939 operated junctions. Neovascularisation was suspected or demonstrated in a total of 142/1081 cases (13.1%). The data obtained from the different centres appeared to be scarcely detailed to define the various tributary veins involved in the mechanism of recurrence; nevertheless, it is possible to assess the prevalence of SS connected with residual tributaries as major causes of recurrence in both the SFJ and SPJ. NN was recently described as the most dangerous enemy of surgeons and patients operated on for varicose veins. The word neovascularisation seems more appropriate to indicate the appearance of new vessels produced by the phenomenon of neoangiogenesis and does not appear to be appropriate, as it refers to pre-existing veins that remain under the impulse of the venous reflux and progressively dilate. Histological observations have led to describe neoangiogenesis as a physiologic process, which follows inflammation and mainly represents a constant product of large wounds, haematomas and thrombosis). The same reparative process, leading to the appearance of specific progenitor cells, takes place in every anatomical district and in every kind of tissue, not only in veins. It can be invoked as a cause of VR in a small percentage of cases, and it seems to play a minimal role at the groin and popliteal region of the operated limbs. In many cases in which no residual tributary could be detected, except for small, weak and tortuous veins, the VR was represented by an anatomical anarchic development of the collateral circulation, similar to cavernous haemangioma. The presence of anatomical residuals at the SFJ and SPJ has been always indicated in the past as the main cause of VR; this research confirms that residual saphenous stump and tributaries caused by inadequate surgery appear to be the main cause of VR at the saphenous junction. Recent studies have clearly demonstrated that the only way to prevent VR is still traditional surgery. The only trap is represented by the presence of anatomical variants at the junctions but DUS investigation systematically performed before applying any therapeutic technique can prevent such difficulties.

Direct popliteal artery perforator flap： anatomical study and clinical application

Objective To investigate and evaluate the clinical effect of the direct popliteal artery perforator flap. Methods Thirty embalmed lower limbs of adult cadavers which perfused with red latex were used to dissection, major observations were the origin, perforators and anastomoses regulations of the direct popliteal artery. Based on the anatomical study, direct popliteal artery perforator flaps were designed and used clinically to 7 patients who had soft tissue defects in popliteal fossa. Results The direct popliteal artery perforator was direct started from lateral wall of the superior segment of popliteal artery, and about 7-11 cm above knee joint. Then it goes up along the middle line of posterior region of thigh, and pierced from the carvity between semitendinosus and biceps femoris and gave off several branches in superficial fascia. Finally, these branches anastomoses with many perforating branches which were gave off form deep femoral artery （the 1 st to 3rd perforator artery） , obturator artery and lateral circumflex femoral artery. Clinically, all flaps were survived eventually, and 6 of them were healed quickly, only 1 case needed to change dressings to healed its partial necrosis for the pedicle had too much soft tissues and too swelling to block its blood supply. After 2-12 months of following-up, the colors and appearances of these flaps were excellent, and the function of knees were nearly normal. Conclusion Direct popliteal artery perforator flap has relatively constant location and sufficient blood supply to use in clinical application, it is safe and easy to use for recovering soft tissue defects in popliteal fossa. Key words: Direct perforator of popliteal artery; Perforate flap; Popliteal fossa; Applied anatomy

Therapy of catheter-directed thrombolysis for inferior vena cava thrombosis after filter implantation

To evaluate the efficacy and safety of catheter-directed thrombolysis (CDT) in treating with inferior vena cava (IVC) thrombosis after filter implantation. A retrospective analysis of 13 patients with IVC thrombosis after filter implantation was conducted at our institution from June 2009 to June 2012. A total of 26 lower extremities were involved.IVC filters were implanted via right internal jugular vein. Then CDT was performed through small saphenous vein, popliteal vein or femoral vein. The dosage of urokinase was 0.6-1 million/day. The occlusive segment in IVC was managed with percutaneous transluminal angioplasty (PTA) and stenting. The obstructed IVC was re-opened after CDT in 11 cases. The average CDT time was 8.3 (7-13) days. PTA (n = 2) and stenting (n = 1) were performed. A total of 4 retrievable filters were planted and retrieved later successfully.No severe complications occurred. During the follow-ups, no clinically detetable sighs of pulmonary embolism were observed. CDT is effective, safe and feasible in the treatment of IVC thrombosis after filter implantation.

Diagnostic value of high frequency color doppler ultrasound for lower limb artery lesions in patients with diabetes

Objective To explore the clinical value of high frequency color doppler ultrasound in the diagnosis of lower limb artery pathological changes of diabetes.Methods Linear array of high frequency probe was used in regular line double lower limbs artery ultrasound examination in 102 cases with diabetes (observation group) and 98 healthy people(control group).The lower limb artery(including femoral artery,popliteal artery,posterior tibial artery,the tibia and dorsalis pedis artery)before the intima-media thickness (IMT)were measured,and the presence of plaque,the plaque nature,the degree of luminal stenosis or occlusion of the judgment and hemodynamic changes were observed.Results In observation group,the femoral artery plaque detection rate was 22％,popliteal artery plaque detection rate was 36％,posterior tibial artery plaque detection rate was 39％,pretibial artery plaque detection rate was 38％,dorsalis pedis artery plaque detection rate was 45％.In control group,the femoral artery plaque detection rate was 9％,popliteal artery plaque detection rate was 7％,posterior tibial artery plaque detection rate was 10％,pretibial artery plaque detection rate was 13％,dorsalis pedis artery plaque detection rate was 16％.In the observation group,lower limb artery plaque caused mild stenosis in 31 cases,moderate stenosis 16 cases,severe stenosis 11 cases,block 4 cases.In the control group,9 cases had mild stenosis caused by lower limb artery plaque,moderate stenosis 5 cases,3 cases with severe stenosis and occlusion in 0 case.In the observation group,lower limb artery soft spot 14,hard spots in 19,41 mixed plaques.In the control group,lower limb artery soft spot 4,hard spot 8,11 mixed plaques.Conclusion Lower limb artery pathological changes is closely related with diabetes,especially the artery stenosis and block the knee can predict the development of diabetes. Key words: Color doppler ultrasound; Lower extremity arterial; Diabetes

Cross-sectional area reference values for normal peroneal nerve by high-resolution ultrasonography

Objective To obtain the comprehensive information of the normal peroneal nerve by high resolution ultrasonography.Methods The cross-sectional area was measured by observing the traveling law of peroneal nerve as well as its ultrasonographic features,choosing the polyline level of popliteal and the peroneal nerve around the fibular neck as measurement point.Results There was no significance on statistics in differences of the above-mentioned cross-sectional area.The overall mean of its peroneal nerve were (0.139 ± 0.043)cm2 and (0.114 ± 0.032)cm2 resectively; and its peroneal nerve among men seems a little bit wider than that among women,the old wider than the youth.It was positively correlated with height and weight(r =0.569,0.625,respectively,both P ＜0.05).Conclusions The high-resolution ultrasound can show the form and shape of the peroneal nerve,thus providing diagnostic criteria in quantity by measuring its normal cross-sectional area. Key words: Ultrasonography; Peroneal nerve; Cross-sectional area

Acute responses of regional vascular conductance to oral ingestion of fructose in healthy young humans.

BackgroundRecently, it was reported in healthy young subjects that fructose containing drinks increased blood pressure acutely, without any apparent change in total vascular conductance (TVC). However, because it is well known that the splanchnic vasculature is dilated by oral fructose ingestion, it is assumed to be the concomitant vasoconstriction in other peripheral region(s) that is responsible for this finding. Thus, the purpose of this study was to determine the acute response of regional VC to oral fructose ingestion in young healthy humans.ResultsIn 12 healthy young subjects, mean arterial blood pressure (MAP), heart rate, cardiac output, and blood flow (BF) in the superior mesenteric (SMA), brachial (BA), and popliteal (PA) arteries, in addition to forearm skin BF, were measured continuously for 2 h after ingestion of 400 ml fructose solution (containing 50 g fructose). Regional VC was calculated as BF/MAP. MAP increased for 120 min after fructose ingestion without any change in TVC. While VC in the SMA was elevated after ingestion, VC in BA and PA and forearm skin decreased.ConclusionsWhile TVC was apparently unchanged during the 2 h after fructose ingestion, there were coincident changes in regional VCs in the peripheral circulation, but no net change in TVC.

Efficacy and prognosis of endoluminal treatment of femoropopliteal chronic total occlusions

To evaluate the efficacy and prognosis of endoluminal treatment of superficial femoral artery and proximal popliteal artery chronic total occlusions. A prospectively collected database of 148 patients (156 limbs) between January 1, 2009 and December 31, 2012 was retrospectively analysed. All the patients were treated with endoluminal interventions. The mean lesion length was (14 ± 11) cm (0.5-41.0 cm). According to Trans-Atlantic Inter-Society Consensus II (TASC II), 47 lesions were type A, 40 were type B, 26 were type C and 43 were type D. Technical success rate, clinical success rate, perioperative limb salvage rate and complication rate were evaluated. Primary patency rate, secondary patency rate, limb salvage rate and survival rate were calculated with Kaplan-Meier analysis. Cox-regression analysis was used to evaluate risk factors associated with loss of primary patency. Technical success rate was 98.7%, clinical success rate was 96.2%, perioperative limb salvage rate was 99.4%, local complication rate was 4.5% and systemic complication rate was 1.9%. At 3, 6, 12, 24 and 36 months after surgery, the primary patency rates were 95.1% ± 1.8%, 80.2% ± 3.4%, 65.6% ± 4.3%, 60.9% ± 4.6% and 53.7% ± 5.8%, respectively. The secondary patency rates were 97.9% ± 1.2%, 94.2% ± 2.0%, 89.6% ± 2.8%, 81.4% ± 3.9% and 78.0% ± 5.0%, respectively. The limb salvage rates were 99.4% ± 0.6%, 99.4% ± 0.6%, 97.8% ± 1.2%, 97.8% ± 1.2%, and 97.8% ± 1.2%, respectively. The survival rates were 99.2% ± 0.8%, 98.4% ± 1.1%, 97.5% ± 1.5%, 94.9% ± 2.3% and 91.2% ± 4.2%, respectively. TASC II C/D lesions (OR = 1.776, 95%CI 1.013~3.116) and runoff score (OR = 1.138, 95%CI 1.016-1.275) were found to be associated with loss of primary patency. Endoluminal intervention was a safe and efficacious method for treating femoropopliteal artery chronic total occlusions.Satisfactory limb salvage rate can be reached despite of the high restenosis rate. TASC II C/D lesions and runoff score were found to be risk factors associated with restenosis.

The feasibility of PICC insertion through the veins of lower extremity in neonates

Objective To investigate the advantage of detaining peripherally inserted central catheter through the veins of lower extremity in neonatal intensive care unit.Methods 165 cases of infants were randomized into veins of lower extremity group (first saphenous veins,then popliteal vein) and veins of upper extremity group (first basilic vein,then median cubital vein,cephalic veins) from January to December 2012.We observed the success rate of detaining,catheter tip location,and complications such as phlebitis in the two groups.Results The success rate of detaining of lower extremity group was higher than that of upper extremity group,and ectopic rate of lower extremity group was lower than that of upper extremity group.There was no significant difference in complications such as phlebitis between two groups.Conclusions Peripherally inserted central catheter through the veins of lower extremity has more advantage over through the veins of upper extremity group. Key words: Peripherally inserted central catheter; Veins of lower extremity; Neonates; Feasibility

The Effective Injection Zone at the Popliteal Crease for Tibial and Common Peroneal Nerve Blocks and its Relation with the Origin Point of the Medial and Lateral Sural Cutaneous Nerves

El bloqueo nervioso popliteo puede ser utilizado para proporcionar anestesia y analgesia prolongada del miembro inferior y para aliviar el dolor postoperatorio severo y duradero. El objetivo fue determinar la localizacion anatomica de los nervios tibial (NT) y fibular comun (NFC) en el pliegue popliteo para un bloqueo nervioso efectivo. Se utilizaron 50 miembros inferiores frescos pertenecientes a 27 cadaveres adultos chinos (16 hombres y 11 mujeres, rango de edad entre 35-87 anos). Se utilizaron 22 cadaveres para identificar la localizacion de los nervios y los 5 restantes para determinar la profundidad de los nervios en una seccion transversal. El NT se encontro en el 50% de los casos desde el punto mas lateral del pliegue popliteo a 1,4 cm de la superficie. En el 20% de 50 muestras, el nervio cutaneo sural medial se ramifico por debajo o en el pliegue popliteo, mientras que el NFC se encontro en el 26% de los casos desde el punto mas lateral del pliegue popliteo a 0,7 cm de la superficie. Ademas, en el 6% de las muestras, el nervio cutaneo sural lateral se ramifico por debajo o en el pliegue popliteo. Nuestros resultados sugieren que el NT y NFC emergen del nervio ciatico a distancias variables del pliegue popliteo. Creemos que los resultados sobre la ubicacion de NT y NFC en el pliegue popliteo ofrecen una buena guia para el adecuado bloqueo nervioso.

Repair of nerve defect with acellular nerve xenograft laden with allogenic adipose-derived stem cells in rhesus monkey

Objective To study the effects after repair of nerve defect with acellular nerve xenograft laden with allogenic adipose-derived stem cells (ADSCs)in rhesus monkey.Methods Experiment time:March 2011 to May 2013.Isolated from the popliteal fossa fat of male Rhesus monkey,ADSCs were microinjected and planted on porcine acellular nerve xenograft by chemical extraction.The radial nerve defect models with 25 mm in length were established in 10 healthy adult female rhesus monkeys,and they were divided into group A,B and C (n =5) randomly,which were repaired with acellular nerve xenograft laden with allogenic ADSCs,acellular nerve xenograft only and nerve autograft.At 5 months after operation,the evaluation of wrist extension,electrophysiology and histological examination of the grafts and wrist extensor muscles were perform for nerve regeneration.Results At 5 months after operation,the recovery rate of wrist extension angle of group A,B and C were (80.53 ± 15.30) ％,(69.06 ± 7.02)％ and (99.91 ± 22.16)％ respectively.The conduction of radial nerve was recovered by electrophysiologcal detection and nerve fibers have regenerated by histological examination.In all indexes,group A was better than group B,while group C was better than group A and group B,which there was no statistical significance.Conclusion Porcine acellular nerve xenograft could repair 25 mm long radial nerve defect effectively in monkeys,whcih laden with allogenic ADSCs may be better than no laden with allogenic ADSCs. Key words: Acellular nerve graft; Adipose-derived stem cells; Xenograft; Rhesus monkey

Diagnosis and treatment of traumatic popliteal artery injury

Objective To summarize our experiences in the diagnosis and treatment of traumatic popliteal artery injury which may help orthopaedic surgeons better understand the traumatic injury to the popliteal artery in patients with knee trauma.Methods We retrospectively reviewed 113 patients with traumatic popliteal artery injury who had been admitted to our department between July 2003 and June 2012.The cohort consisted of 100 males and 13 females with a median age of 33.0 years.The type of arterial injury was A in 34 patients,B in 7 and C in 72 according to the classification proposed by Chen et al.Ninety-five patients presented with acute limb ischemia,and 18 were complicated with compartment syndrome.The popliteal arteries were primarily repaired in 94 patients,including 47 cases of end-to-end anastomosis,40 transplantations of great saphenous vein,3 transplantations of small saphenous vein,one transplantation of accompanying vein and 3 cases of thmmbectomy.Conservative treatment was conducted in 6 patients,fasciotomy in 4 and amputation in 9.The median interval between injury and revascularization was 15.8 hours for the 94 patients who had repaired the popliteal arteries and 32.0 hours for the 23 patients who had been transferred by local hospitals.Results The popliteal artery injuries were surgically repaired in 83.2％ of the cohort (94/113).Amputation was performed in 19 patients after repair,resulting in a limb salvage rate of 79.8％ (75/94).The total amputation rate was 24.8％ (28/113) and the mean interval from injury to amputation was 10.9 days (range,1 to 43 days) for this cohort.The amputations were mainly due to extensive soft tissue necrosis.Of the patients who had been previously treated at local hospital,only 21.7％ (5/23) were diagnosed as having popliteal artery injury prior to referral and 30.4％ (7/23) ultimately underwent amputation.Postoperative complications included soft tissue necrosis and infection in 22 patients,and significant elevation of serum creatine kinase in 6 patients.Conclusions Any trauma involving the knee should highly alert surgeons to a possibility of traumatic popliteal artery injury.All orthopedic surgeons should be familiar with its injury mechanisms,characteristics,clinical manifestations and differences from compartment syndrome before they can timely diagnose and repair the traumatic popliteal artery injury.Meanwhile,they should aggressively treat the concomitant increased compartment pressure. Key words: Popliteal artery; Wounds and injuries; Compartment syndromes